Getting a good night’s sleep is essential for our wellbeing. However, for many of us this is easier said than done. Certain medications and alternative therapies can help you get enough sleep, which for adults is at least 7 hours per night. Those experiencing insomnia, however, may find it very difficult to find a treatment that works.
The research for treating insomnia with medical cannabis isn’t extensive yet. But there are promising results in some studies, particularly in how medical cannabis could help relieve anxiety and chronic pain – two common causes of insomnia.
Different cannabis strains and cannabinoid content are also important to consider when it comes to medical cannabis and sleep, as well as how medical cannabis may affect the different sleep stages.
What is Insomnia?
Insomnia is a sleep disorder. It affects your ability to fall asleep, stay asleep, or wake up at the right time. As you’d expect, insomnia can be challenging to deal with. Long periods of sleeplessness can damage your physical health and affect your work and social life.
There are two forms of insomnia:
Acute insomnia lasts for a few days to a few weeks. It’s often linked to stressful or traumatic life events and can resolve when the stress is decreased.
Chronic insomnia lasts three months or longer and affects your sleep at least three days per week. Chronic insomnia can be harder to overcome, as many potential causes exist.
A report commissioned by the Sleep Health Foundation found that people in stressful situations such as financial instability and unemployment are more likely to experience insomnia, as are women and older people. Other health conditions can cause insomnia, but sometimes the cause is unclear.
How Common is Insomnia in Australia?
Sleep issues are very common: more than half of Australia's adult population report at least one chronic sleep issue affecting their quality of life.
The Sleep Health Foundation’s report also found that over 60% of responders struggled with at least one sleep issue, such as trouble falling or staying asleep. 14.8 percent of people also met the diagnostic criteria for clinical insomnia.
Significantly more females than males reported worrying about their sleep quality (31% vs 21%) and experiencing racing thoughts that made it hard to sleep.
Using Medical Cannabis For Insomnia
Early research suggests that THC and CBD, the two most prominent cannabinoids in Cannabis sativa, could offer some relief if you are experiencing insomnia. Studies suggest CBD and THC’s therapeutic benefits such as pain relief and relaxation may be how they help us fall asleep. Currently, most research is on how medical cannabis affects those who have self-reported insomnia symptoms.
Some studies have examined how certain people use CBD for anxiety and sleep issues. In one study, which looked at people’s reasons for using CBD, anxiety was the most common reason, followed by stress, general wellbeing, and then to improve sleep. 125 out of 387 study participants said they used CBD to help improve their sleep, while 95 out of 387 said that CBD improved their insomnia.
THC is well known for its sedating and psychotropic effects. Low doses of THC combined with higher doses of CBD may be helpful for insomnia, because THC in low doses can provide the sedating effects while CBD may offset anxiety. While this is promising, more research needs to be done before making any definitive claims.
Medical cannabis’s effects on anxiety could ease symptoms at night, allowing for a more restful sleep. This also applies for those experiencing pain or muscle spasms.
While sleep disorders are one of the most commonly cited reasons for prescribing medical cannabis, the lack of studies on CBD and THC for people with insomnia means that they can’t be considered first-line treatments.
Medical Cannabis For Obstructive Sleep Apnea
There is debate among researchers about whether medical cannabis may be an effective treatment for obstructive sleep apnoea (OSA).
A 2018 study found some positive results with 73 adults experiencing moderate to severe OSA. They were given either a placebo or Dronabinol, a drug containing synthetic THC. The people who were given Dronabinol experienced a reduction in their sleep apnea symptoms, but the study mentions that larger clinical trials are needed to clarify whether cannabinoid therapy could help with OSA.
However, the American Academy of Sleep Medicine (AASM) don’t support using medical cannabis for OSA. They argue that there isn’t enough evidence, and that certain side effects of medical cannabis such as daytime sleepiness and weight gain may be dangerous when combined with the existing symptoms of OSA.
Another more recent review of studies on medical cannabis and sleep disorders was also sceptical, but acknowledged the potential medical cannabis may have for treating sleep apnea. The review highlighted the need for larger and longer term trials to study the safety and effectiveness of cannabinoid therapy for sleep apnea and other sleep disorders.
Does Medical Cannabis Interact With Other Prescriptions For Insomnia?
Medical cannabis is generally well-tolerated, but it’s always a good idea to ask your doctor about any interactions it may have with other sleep aids. It’s also important to know how your body processes medication.
Sedating medications such as benzodiazepines, certain antidepressants, opioids, antipsychotics and some antihistamines may cause excessive drowsiness when combined with medical cannabis, potentially leading to falls or other accidents. Some herbal supplements such as St. John’s wort and kava can cause similar issues.
Some medications for insomnia are broken down by a hepatic enzyme called CYP2C19. Medical cannabis, specifically CBD, may interfere with this enzyme, causing other medication to not break down as quickly. Speak to your doctor about this, as it can be dangerous when medication isn’t broken down properly in your system.
Some insomnia medications may be safe to take alongside CBD. One study looked at the effects of a medication that combined CBD with melatonin, a common sleep aid that helps regulate the body’s circadian rhythms. The results were promising, with patients reporting improved sleep with minimal side effects.
Melatonin with CBD could still carry risks though, as it may also lead to excessive sleepiness. Talk to your doctor about what medications are safe to take alongside medical cannabis.
Indica vs Sativa: Different Cannabis Strains and Their Effects on Sleep
You’re likely aware of the idea that different cannabis strains produce different effects. While this is in some ways true, the full story is more complicated – especially when it comes to selecting a strain to help you sleep.
Indica, sativa and hybrid are the three main terms you’ll hear when discussing medical cannabis strains. Indica is associated with a more sedating, relaxed feeling, while sativa users typically report feeling more energised or euphoric. This is likely due to indica strains often containing higher amounts of CBD than THC, and vice versa.
Essentially all modern cannabis strains are hybrids, meaning that the distinction between indica and sativa holds less meaning now than it may have long ago. Current literature suggests that the unique effects of different cannabis strains are more dependent on the terpene and cannabinoid content. Certain terpenes may be more sleep-inducing than others, but this is yet to be confirmed in human studies.
One study had participants log their experience with using cannabis as a sleep aid. The participants generally reported more relief from insomnia and fewer negative side effects with indica compared to sativa.
Risks of Using Medical Cannabis for Sleep Disorders
Using medical cannabis for sleep disorders does carry risks. Products containing only CBD are generally well-tolerated, but THC products may affect sleep in several ways, some of which aren’t well known.
While CBD doesn’t appear to directly affect sleep, THC may alter your sleep architecture – meaning how long the different stages of sleep last. THC may shorten the rapid eye movement (REM) period of sleep, while extending the deep sleep stage, but more studies are needed to confirm this.
REM sleep is when dreams occur. Modifying REM sleep may be beneficial if you experience nightmares, common with conditions such as PTSD, but REM sleep is also important for processing emotions and cementing new memories. Whether altering your sleep like this is beneficial for you is something to discuss with your doctor.
High doses of THC at night may also cause unwanted side effects the following day, such as drowsiness and impaired memory. It’s important to find the right dosage with the guidance of your doctor to mitigate the risk of this from occurring.
Alternative Therapies for Insomnia
The research around medical cannabis and insomnia is still in its early stages, and there is some disagreement about how effective it may be for sleep disorders such as obstructive sleep apnea.
That being said, there are some promising early results. Insomnia affects many people and can be debilitating, so more research into alternative therapies such as medical cannabis could be beneficial for many people.
You and your doctor may decide to try using medical cannabis as a sleep aid. If so, you’ll discuss what strains, cannabinoid and terpene content are best for you.
Medical cannabis can be used alongside alternative therapies to significantly improve your sleep. You may want to supplement your medication with other alternative therapies such as yoga and meditation, which have well-documented benefits for sleep and general wellbeing.
A holistic approach like this can help improve sleep. Insomnia and other sleep disorders can be very difficult to deal with, but there are several treatment options that you can discuss with your doctor.